Individual provider Active NPI

Nino Vittorio, M.D.

  • Internal Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1710990239
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD036613 Issued in PA
Practice address
1720 S Broad St
Health Care Center #2
Philadelphia, PA 19145-2315
Phone
(215) 685-1803
Fax
(215) 683-1815
NPI assigned
Aug 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD036613 PA Primary

Addresses

Primary practice location

1720 S Broad St
Health Care Center #2
Philadelphia, PA 19145-2315

Mailing address

500 S Broad St
Suite 360
Philadelphia, PA 19146-1613
Phone (215) 685-6769

Other identifiers 1

IdentifierTypeStateIssuer
0011378510001MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110511000244 PA Practitioner - Internal Medicine 4789860644 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD036613PAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
City of Philadelphia CurrentSince Mar 26, 2011 Accepting new patients
City of Philadelphia CurrentSince Mar 26, 2011 Accepting new patients

Locations

4400 Haverford Ave
#4
Philadelphia, PA 19104
Phone (215) 685-7600

500 S Broad St
Ste 360
Philadelphia, PA 19146

4400 Haverford Ave
Philadelphia, PA 19104
Phone (215) 685-7504

1101 Market St
Fl 10
Philadelphia, PA 19107

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1710990239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 S BROAD ST",
            "address_2": "SUITE 360",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191461613",
            "telephone_number": "215-685-6769",
            "fax_number": "215-685-6732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 S BROAD ST",
            "address_2": "HEALTH CARE CENTER #2",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191452315",
            "telephone_number": "215-685-1803",
            "fax_number": "215-683-1815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VITTORIO",
        "first_name": "NINO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD036613",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0011378510001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.